Healthcare Provider Details

I. General information

NPI: 1306968680
Provider Name (Legal Business Name): GILSON VILA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2257 MAIN ST
SPRINGFIELD MA
01107-1905
US

IV. Provider business mailing address

49 GERRARD AVE
EAST LONGMEADOW MA
01028-1605
US

V. Phone/Fax

Practice location:
  • Phone: 413-733-3488
  • Fax: 413-731-7381
Mailing address:
  • Phone: 413-781-3988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number228966
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: